Combined annual report of the Columbia-Presbyterian Medical Center /

Resources for Healing:

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On the cover: Colunjbia-Pn-sbytrrian
Medical Center s infant transport team
rushes a critically ill newborn to the
Center s Neonatal Intensive Caie llnit.
Columbia- Presbyterian is one of eiftht
medical centers in tbe nation serving as a
n-gional center for the can- of seriously ill
infants.

-A. modern academic medical center is an enter-
prise of nearly unimaginable complexity. As in any
large organization, the skill with which it marshals
its human and physical resources is vital to its
success. Sound management, fiscal responsibility,
organizational strength — all matter, and
matter greatly.

Despite the importance of organization, a medical
institution must always understand that the final
measure of its achievements is how well it serves a
human life in need of help. Great medical centers
are, first and foremost, great centers of treatment
where the individual patient can draw upon all the
resources of medicine. Always, they have as their
final objective the improvement of the healer s art.
This report presents some graphic illustrations of
how Columbia-Presbyterian Medical Center’s
extraordinary capabilities and accomplishments in
clinical care, biomedical research, and medical
education affect the course of patient treatment. Not
only do these exemplify the exceptional resources
available to every patient under our care, but they
also document how the Center’s intellectual and
scientific talent is advancing medical art and
science worldwide.

From left to right,

Henrik Bendixen
Acting Provost and Vice President
for Health Sciences. Columbia
University in the
City of\eu- York
Felix E. Demartini
President, Presbyterian Hospital
in the City of.\ew York
Michael I. Sovem
President, Columbia University
in the City of . Sew York
Edward H. Noroian
Executive Vice President,
Presbyterian Hospital
in the City of Sew York

Resources for Healing:
Obstetrics/Pediatrics

Baby Calabrese
and the Rh F actor

Neonatal Intensive Care Unit
One of the world's most sophisticated
facilities for newborns in need of ad-
vanced life-support services, this
30-bed facility includes a staflOf
eight full time attending neonatol-
ogists, a full time anesthesiologist, 70
nurses and eight postdor'toral fellows.
Kaeh patient station is monitored by
noninvasive sensors for heart rate and
breathing. Oxygen levels of the most
seriously ill infants are also moni-
tored continuously. \ satellite labora-
tory provides mund-the-eloek

analyses of blood gases and acid-base
states of the infant using micro-
methods that re(]uire only a fraction
of a drop of the baby's blood (essen-
tial for premature babies whose tinv
bodies typically hold no mom than
three ounces of blood).

These teehniciues, combined with an
interdisciplinary team approach to
the managment of the care of eritie-
ally ill infants, have helped pniduee a
dramatic decline (illustrated to (he
right) in the mortality of low-birthweigh(
babies at Columbia- Presinterian.

When in 1964 Linda Calabrese bore a healthy
baby girl, the happy event spelled tragedy for
her subsequent pregnancies. The very act of
birth had triggered a destructive inimunoreac-
tion to the blood of each of the six babies she
would conceive over the next 16 years.

Linda had developed Rh sensitivity, an
affliction of women with Rh negative blood who
carry or bear Rh positive babies. In such
pregnancies, the woman’s immunological
system may react to the baby as it would to a
disease, attacking the developing fetus’ Rh
positive blood cells, producing severe anemia,
heart failure, and death. (An earlier abortion or
miscarriage of an Rh positive fetus, or an
ac(udental transfusion of Rh positive blood, can
produce the same reaction.)

Rh disease has been one of the most frc(juent
causes of fetal mortality. Two decades ago, it
killed as many as 10, 000 babies annually in the
U.S. alone. But today, the disease is almost
completely preventable. In 1961, two groups
working independently, one in Liver[)ool and
one at Columbia-Presbyterian, developed the
solution. The Columbia-Presbyterian team,
l)rs. Vincent h'reda, John Corman, and William
Pollack of the Depailrnents of Obstetrics and
Cynecology and Pathology developed a drug
called RhoCAM. If no .sensitivity has yet been
developed, a single injection of RhoCAM,
giv<*n to the mother after the birth of her first
Rh [)ositiv(* child and aft(*r each .subs(‘(|uent

delivery, suppresses the production of
antibodies to the fetal red blood cells. Since
RhoCAM was licensed by the United States
government in 1968, it has saved the lives of
tens of thousands of babies the world over.

Unfortunately, RhoCAM was not available to
the general public in 1964 when Linda
Calabrese gave birth to her first, normal (but
Rh positive) baby. In the years that followed,
the consequences were heartbreaking. Linda
endured a series of tragic pregnancies,
including two Rh related stillbirths, an
Rh effected baby with Down’s syndrome who
was successfully delivered after 33 weeks but
died shortly after delivery, a miscarriage, and
an ectojhc pregnancy that ruptured her left
fallopian tube.

But by the time of her seventh pregnancy, in
1980, biomedic‘al science and antepartum and
neonatal intensive care had pn)gressed enough
to treat Linda’s illness. By then, she had come
under the care of Columbia-Presbyterian. The
Center’s pioneering work on Rh disease had
earned it a worldwide reputation in the
obstetrical treatment of Rh negative women.
Linda was nderred to Dr. Freda by her own
obstetrician.

Fourteen to sixteen weeks after gestation,
amnioc(‘ntesis was perfornu'd in conjuiu'tion
with idtrasound by a nxMiibcrof tiu* Clinical
(hmelics t«‘am. A sample of amniotic fluid was

2

i

tirtliHri^lit ami IVriiiatal Mortality
t (^olunibia-PreHhytrriaii

liirtliwrighl

. In gram>* Mortalilv KaU*

l')7()

D)80

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76..A9'f

55.5<7r

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2(>.79f

18.6%

•A(K)-2(XH)

l‘).77f

\XWc

8.0%

t I

J IBinlivseiglit (or normal haltios averages
' |.'i5(K) grams.

i

.\<lvaiieeil Fetal Monitoring

(ainlinnous monitoring ol hahies (lur-
ing labor and deliverv was developed
at the Center and is now routine prac-
tice f(»r nearly all deliveries at
I’resbyterian Hospital. \ minicompu-
ter autoniatically records letal heart
rate and intrauterine pre*ssun* tlmnigh
special sensors and analyzes and pn--
sents the data to the [divsician on
conimund. The computer system can
also issue an alarm to attending
physicians or nurses when it detects
signs of tnnihle. The Center also
pioneered the use of ultrasonographv,
which uses high frecpiencv sound to
monitor fetal hreathing.

Perinatal Program

Columhia-I’reshyterian, tlmnigh its
Perinatal Division, has led an inter-
national trend in the coonlination of
msearch and clinical care in pediat-
rics, obstetrics, and anesthesiologv,
especially in the management of high
risk pregnancies and infants. team
of specialists meets each week to re-
view )>atient problems and to discuss
possible courses of treatment. .A full
attending stafi of perinatologists can
be mobilized instantly to pnivide in-
tensive care during labor, delivery,
and early neonatal life.

Hiioreseeiil Polarization
of .Amiiiotie Fluid

Lung maturity is a critical nieasim' of
a premature baby’s susceptibility to
n'spiratory difficulties, the primary
cause of death among low birth-
weight, high-risk newborns. Inves-
tigators in the Center’s Perinatology
Clinic Service in c(dlaboration with
the Department of Physiology have
developed an accurate, rapid method
to measure lung maturity, one that
uses fluorescent polarized light to
analyze the amniotic fluid. The
method enables tbe attending team to
decide <|uickly whether a fetus in
danger can be safely delivered.

Obstetrics! Pediatrirs rout.

Re^onal Perinatal Network

Coluinbia-Prcshyterian Medical Cen-
ter is one of eight medical centers in
the nation awarded grants fnnn the
Robert Wood Johnson Foundation
to serve as a regional center for
perinatal care for critically ill infants.
Nine hospitals in western and upper
Manhattan, New Jersey, Westchester
and Rockland (bounties, and Connec-
ticut are part of the network and refer

high risk cases to the Center. \ spe-
cially furnished ambulance and
transport team, includitig neonatal-
perinatal specialists, is dispatched to
the referring hospital to stablize the
infant prior to transfer to the Center
for treatment. Network patients are
guaranteed admission to the Center.
.3.5% of admissions to the Center’s
Neonatal Intensive Care Unit come
from network hospitals.

Infant Stimulation and Bonding

Research has shown that early, inti-
mate r'ontact between a newborn and
its mother increa.ses the likelihood of
a strong, happy relationship through-
out childhood. Presbyterian Hospital
pn)vides a bonding period soon after
normal deliveries and encourages
frequent mother-child contact during
the hospital stay. A special infant
stimulation program is also offered to
parents of newborns in the Neonatal
Intensive (iare Unit. Parents are per-
mitted 24-hour visitation and physi-
cal therapists work with mothers to
help them overcome their fear of
touching their tiny premature babies.

Perinatal and Obstetrical
Consultation Hotline =

Physicians thmughout the metrupoli-
tan area can consult Columbia-
Presbyterian clinical specialists in
obstetrical and perinatal medicine
instantly by dialing the Regional
Perinatal Network's hotline number.

.A team of Center nurses also provides
training in the neonatal care of pre-
mature infants to the nursing staffs of
network hospitals.

Baby Calabrese cont. needed for genetic analysis, a step essential

due to Linda’s previous delivery of a fetus with
Down’s Syndrome. The test has become a
routine procedure. Ultrasonography, a new
imaging technique, allows the obstetrician to
note the exact position of the fetus in the womb
before inserting the needle. A decade ago, prior
to the development of ultrasonography,
amniocentesis this early in the pregnancy might
have been fatal to the developing fetus.

The test indicated that Linda was carrying a
healthy male infant with Rh positive blood.
Careful monitoring of her pregnancy would he
essential.

In most cases of Rh disease, the developing
fetus must have one or more intrauterine
transfusions, wliic^h give the hahy blood ri(di in
red cells to replace those destroyed by the
mother’s antibodies. Such transfusions are
administered to extend the baby’s life in the
womb, and thereby increase its chances of
survival. At 27*/2 weeks of pregnaii(;y. Dr.
fVeda took another arnniotic sample to analyze
the baby’s condition. The signs were favorable.
A transfusion would not he nee(h*d.

Within days, however, Linda began to notice a
decrease in tlie baby’s activity. At 28*/2 weeks
Dr. Freda took another arnniotic sample. This
time, lie also injected a dy(“ that would enable
him to d(*terrnine via x-ray whether the hahy
was swallowing arnniotic fluid, a vital sign of
fetal health. The hahy was barely swallowing at
all and tin* color of the arnniotic fluid showed
signs of trouble.

Another tap at 29V2 weeks revealed a green
tinge in the arnniotic fluid. It was time to act.
The next day. Dr. Freda performed a Caesarean
section and delivered a severely anemic, but
remarkably lively two-pound baby.

Six or seven years ago, a Caesarean at this stage
of pregnancy would have been done only to save
the life of the mother. The baby’s chances of
survival after birth would have been nil. Tiday,
however, remarkable improvements in neonatal
intensive care mean that critically ill babies
can he delivered as early as 27 weeks after
conception with better than even chances of
survival.

Why? The Calabrese infant’s story illustrates
what a great medical center can now do for the
newly horn and critically ill patient. Fixxn the
moment Linda was wheeled into the delivery
room, the most so|)histicaled medical services
in the world were put into actioti. Some
examples:

• An interdisciplinary team of obstetricians,
pediatricians, perinatologists, neonatologists,
anesthesiologists and other specialists
coordinated and supervised the infant’s
treatment.

• Com[)uter monitoring was used during
childbirth to track the baby’s vital signs.

• A satellite lahoratoiT adjoining the deliven
iDom made possihh' ra|)id tests of the baby’s
condition.

• liansitional intensive care facilities on the
dclivciT floor were used to stabilize the

4

Geni‘li<‘ Dia^iioHiM uiiii (l«>iiiiHeliii^

The risks of pfiictic ilisonicrs art-
known to l)f gn-atcr in l>al>ics horn to
pan'iits o%<‘r iiS or to parents w itii a
taniiK liistor\ ol inherited disease.
Man\ such pannits t\ piealK pndi-r
aixirtion to the risk ol a damaf'ed
hah\. Ciolinnhia- l’resh\ terian's l’n>-
gram in (dinieal (ieneties pn>vides
g<*netie diagnosis to such pannits and
counsels them t>n the meaning, pn>g-

nosis, and <'linieal treatment ol birth
disorders. In eases where eoneeption
has already occurred and the letus is
determined to he- at risk lor a genetic
disc-ase, amnioeentesis is olh-n-d to
screen the letus lor |)ossil>le chromo-
some damage. Since the- vast majority
ol the tested letusc-s pneve to he nor-
mal, the n-sult is a n'duclion ol the
numlwr ol unnecessar\ abortions.

Reproductive Science

Down's syndnnne and other genetic
disonlers arc- known to result Irom er-
rors in the division ol chnemosomes in
human cell clevc-lc)|)ment. learns ol
sc-ic-ntists in the- Center's Interna-
tional Institute lor the- Study of
Human Ke|)nicluc-tion are exploring
the- mechanisms of the pniteins that
distribute chinmosomes. They
bc-lic-vc- that thc-ir rc-search may even-
tually lead to an understanding ol the
location in l)\.-\ ol such erners. Once
the location ol the error is known, it is
possible that recombinant technology
could be used to corn-ct the ernir.

General Obstetrical and
Pediatric Group Practice

Mc)thc-rs and children are given pc-r-
sonalized treatment on an appoint-
ment basis by gnnips ol obstetricians,
pediatricians, nurse-practitioners,
and othc-r health workers organized to
pnevide regular health c-are to
Columbia- Presbyterian's neighboring
communities. The Group Practice fo-
cuses on such preventive measures as
check-U[)s, vaccinations, counseling,
and vision tests.

newl)orn baby’s contlition before transfer to
tbe Neonatal Intensive Care Unit.

•The infant’s arterial oxygen level, a critical
life sign, was constantly monitored.

•Tbe babv was fed immediately to supply
calories and stabilize his postnatal condition.

• Proper body temperature was carefully
maintained.

• Oxygen was administered to sustain
respiratory function.

Today, the procedures listed above are routine at
Columbia- Presbyterian with babies such as
Linda’s (and have been widely adopted in
hospitals around the world). So also is the
concept of focusing a dozen or more obstetric
and pediatric subspecialties on the single
problem of saving the life of a newborn.

Yet, as recently as the early 60s, when
Columbia- Presbyterian Medical Center built
one of the first neonatal intensive care units in
the U.S., few of these procedures were used.
Under accepted medical practice at the time,
critically ill babies were not immediately fed,
vital signs were rarely monitored, oxygen
administration was limited for fear of damaging
babies’ eyes and lungs, and the acidic state
caused by the trauma of birth was considered
normal.

Columbia-Presbyterian pioneered many of the
advances that have revolutionized care of
seriously ill newborns. T) these achievements,
Linda Calabrese’s baby, now a thriving, healthy
child, owes his life.

5

Resources for Healing:

Measuring Cholesterol

The relation between cholesterol
turnover and metabolism in normal
persons and in people with abnor-
mally high cholesterol counts is the
subject of extensive research. After
nearly a decade of study, the Center s
researchers have determined a set of
equations that describes in numerical
terms the production and storage of
cholesterol in the body and
bloodstream.

Noninvasive Diagnosis
The use of surgery or other invasive
techniques to diagnose heart disease
always involves risk to the patient.
Where the risk level is too high, non-
invasive methods are preferred.
These range from such basic tech-
niques as use of the stethoscof)e and
ECG to the infusion of chemical or
isotopic materials that can be
scanned.

Heart Disease

George Alexander’s
Chest Pains

In August, 1979, a young executive named
George Alexander, a resident of Manhattan’s
Upper East Side, paid a visit to the Columbia-
Preshyterian Medical Center’s Specialized
Center on Research in Arteriosclerosis Clinic
(SCOR), which is located on the third floor of
the Center’s Dana Atchley Pavilion. In general,
his health was excellent, hut a routine checkup
had revealed one potential health problem, an
ahorrnally high concentration of cholesterol in
his bloodstream.

This SCOR Clinic, directed by Dr. DeWitt S.
(Goodman, is one of only eight in the U.S.
established by the National Institutes of Health
to conduct clinical research into all aspects of
arteriosclerosis. The SCOR Clinic is deeply
interest<“d in cholesterol, an irnf)ortant factor in
the develo[)rnent of heart disease. The body
makes a certain amount of cholesterol in
addition to what it ingests in food, and
evidently needs it as a coiti[)onent of cell
structure. Insoluble by itself in blood,
cholesterol travels through the circulatory
system in chemical packages called
lipoproteitis. In its most familiar and most
alarming manifestation, it forms deposits on the
itiner walls of the blood vess(*ls within the heart
and can clog th<‘tn entirely, d(*|)riving tlu* heart
mu.scle itself of blood and causing a tnyocardial
infarction, the classic heart attack.

Whih' a good deal is known about cholesterol,
much about its behavior is puzzling, ev<Mi

mysterious. Nobody understands, for example,
why cholesterol accumulates in some parts of
the body — the blood vessels, the adipose or
fatty tissues, the tendons, and on occasion the
skin — and not in others. Also perplexing is the
question of why some people with very high
blood cholesterol do not develop thick
vessel-wall encrustations while others, with low
cholesterol levels, do. There is, in sum, ample
reason why one of the main activities within the
SCOR Clinic is a study, which has already
involved about 100 patients over a ten-year
period, of what the Clinic’s director. Dr. Robert
H. Palmer, terms “whole-body cholesterol
turnover.”

T) take part in the study, the individual must be
free of certain ailments that in themselves
generate high cholesteix)! levels. He must be
willing to undergo special blood tests six times
over a nine-month span. And he must agree to
follow a stabilizing diet devised by SCOR’s
nutrition specialists. George Alexander (|ual-
ified on all three counts. One other aspect of his
health background, although hardly reassuring
to him, was of considerable inlen'st to the
cholesterol n'searchers. Ih‘ recounte<l a family
history of heart attacks at young ages. The
possibility of a genetic predisposition to
cardiovascular pn)blems is one SCOR is eager
to investigate.

Over the nine months, (ieorge called at the
clinic n'gularly and, without incident, had his

U

(Cardiac Surgery Research

lmpn)vemenl of methods to sustain
heartbeat is a central foems of canliac
surgery research. A heart stoppage
that may be resistant to straightfor-

Eehoeaniiugrapliy

The echocanliograph is an adaptation
of wartime sofiar. sjn-cial machine
reconls the pattern of sound impulses
transmitted to and tebounding fn>m
the heart. The piufde traced by the
sound can In* studied for ev idence of
abnormality.

The Thronihosis Research Group
Vt hen the interior wall of an artery
suffers damage, blood platelets (the
blood cells res[K)usible for coagula-
tion or clotting) gather at the site.
There, they secrete various
substances, including a gmwth factor
that may stimulate the formation of

arteriosclen)tic pla<]ue. The rise of
this gmwtli factor is under study by
the Thmmbosis Resean-h Group. The
Gnuip is also at work on a blood test
which will detect blood clots in the
veins, or thmmboembolisms, before
they form and threaten the lungs.

wanl electmpulse stimulation may
resfKjnd to counterpulsation or to
stimulus with solutions of cold [)otas-
sium. All of this research is aimed at
minimizing the risk to the patient of
the major open-heart pmcedures,
which may be essential but which se-
verely tax the cardiovascular system.

1

Heart Disease cant.

Exercise Diagnosis
(iolumbia-Frc.shylerian has con-
ducted extensive studies of the effect
of mild stress exercise two weeks after
heart attack. The purpose is diagnos-
tic to see if problems of arrhythmia.

rec]uiring special medication, devel-
op in the patient. The technicjue is
now widely used in the management
of severe heart attack cases.

George Alexander rant.

Cardiovascular Computer Center

In 1976, a grant to the Department of
Medicine permitted the establish-
ment of a Cardiovascular Computer
Center to serve the basic science
departments, medicine, pediatrics
and surgery. The Center has since
begun a program of placing on com-
puter tape the complete reconls of all

cadiovascular patients in the hospi-
tal. One recent study involves the
computer analysis of ECG readings of
all patients during the critical year
after their discharge fnrm the hospital
following surgery. It is hoped that the
analysis will reveal ECG patterns
which would be early warning signals
of heart attack.

I 1

Arrhythmia Control

The irregular heartbeat that may sig-
nal cardiac arrest or may follow a
heart attack is called arrhythmia.
Columbia- Presbyterian's .\rrhvthmia
Control Unit is investigating various
types of anti-arrhythmic drugs and
their effects on the nerve fibers that
contml the heartbeat. The Unit's find-
ings have already led to successful
medications for transient or occa-
sional arrhythmia. Successful drug
therapy for more severe cases would
involve less risk than implanting a
pacemaker.

I

blood sampled for cholesterol turnover tests.
When these measurements were completed, he
stayed on as a participant in another test, a
study of a new cholesterol-lowering agent. Part
of the purpose of administering the second test
was to find out, by repeating the turnover
measurement later, if the new drug had had the
beneficial effect of depleting George’s total
body store of cholestrol.

But in September, 1980, George mentioned to
Dr. Palmer that he was feeling mild chest pains
and occasional shortness of breath. These, of
course, may be symptoms of cardiovascular
illness. Dr. Palmer immediately referred him to
a young Golurnbia- Presbyterian cardiologist.

Dr. James A. Reiffel. Dr. Reiffel administered a
stress test, monitoring the performance of
George’s heart while he exercised on a
treadmill. The finditigs were disquieting. Dr.
Reiffel asked Dr. Paul J. Gannon of the
Diagnostic Gardiac Gatheterization Laboratoi^
for further, and more precise, tests of (George’s
heart function. A couple of twinges, so to
speak, wen* enough to transform (h*orge
Alexand(*r from a clinical volunteer into a
full-fledged cardiac patient.

(h*org(*’s treatment began in the Gath Gab with
diagnostic |)erfusion scatis of the heart and the
network of blood vessels h*ading into and out of
his heart. First, George was given an injection
of thallium 201. I'his ch<*mical is a
radionuclide, a tracer substance giving off

radiation just strong enough to be detectible but
far too weak to do harm. Then, as George
exercised, the laboratory observers used a
scanning camera to track the thallium as it
made its way into his myocardial region. Four
hours later, the scan was repeated, this time
with the heart not under stress. .Apart fmm a
single prick of the needle, the whole pnx'edun*
was painless. The results, however, bore out
Dr. Reiffel’s preliminary imj)ression of
extensive coronary disease. The indication was
that George was developing blockages of the
main coronary arteries.

The next diagnostic stage was the use of the
techni(|ue which gives the “Gath Gab" its name:
the threading of a thin, hollow, flexible tube, or
catheter, into a major artery (often, the femoral
arterv) and along the arterial i)atlnvay into the
heart itself. This pn)cedure, too, involves little
discomfort — much less than the description
would suggest. And it permits the use of
angiograms, or motion-picture x-rays, which
can locate with great exactii(*ss the site and
extent of a blockage.

(h'orge’s cardiac cath(*therization demon-
stratetl conclusively that art<*rial blockages
were occurring at points in the arteri«*s
particularlv susceptible to cholesten)! builil-u|)
and difficult to n*ach by mechanical means, for
sonx'one like George, with exc(*ptionally high
cholesterol counts, a partial blockagt* in that
location would almost certaiidv w()rs«*n, and

Viorkplace Hy|>*‘rteii!ti«>n ll-Htiiij!
Iligli lilootl piicssiin-. nr li\ pcrlnn-
>ion. i> known to lx* a dcaillN illness
in its own rijilit. Its carK (lftcctii>n is
\ital — Net, in its earls stages high
hlood pressmv registers no warning
>\mptonis. The hest was to eheek lor
e\iileneeol high hlootl pii-ssiire is to
administer the standani hlood-pii-s-
sure tests at\d to eheek rnedieal

histories (or eviilenee o( lamilial ear-
dioNasenlar pn)hleins. And the hest
|)laees to eondnet such tests an- the
ofliees and laetori«-s when- p»-o|)le
work. Dr. Ix-slie I*. Haer ot Colnmhia-
I’reshs teriati din-ets a pn)gram
encouraging einplovers to ofler hv|)er-
tension testing and treatment at the
NNork location.

Cardiovasi'iilur Surgery
In lyyy, the surgical stall 0( (a>lnm-
hia-l’reshyterian Medical (a-nter
perlormi-d 700 open-heart surgical
pnH-ednres. I'he (diest & Cardiac
Surgical Service runs the only open
heart pn)gram in New Aork State
which pn)vides complete clinical

facilities lor adults, children and car-
diac transplant cases. In 1081, the
service will move to new operating
n)om and recovery room facilities on
the 17th floor of Preshyterian Hospi-
tal. Pile new facilities w ill make
possible a 1.5 per cent increase in
caseload, to BOO cases per year.

worsen rapidly. Inaction might shorten George’s
life. Working in George’s favor. Dr. Reiffel felt,
was his youth, his good physical condition, and
the fact that his blockage had been discovered
before total closure occurred.

Dr. Reiffel set up an appointment with George
to advise him that, to end the dependence of his
heart muscle on the clogged arteries, coronary
bypass surgery was necessary. George agreed.

In November, 1980, the surgery was performed,
with excellent results.

Since the operation, George has been under the
watchful eyes of physicians from other clinical
units. His only post -operative symptoms were
occasional irregularities of heartbeat similar to
those suffered by about 30% of all heart-surgery
patients. Research bv the Arrhythmia Control
Center, under Dr. J. Thomas Bigger, has led to
the development of highly effective medication
for the condition. The Thrombosis Research
Group and Dr. Palmer’s Lipid Clinic are also
monitoring George’s cardiovascular functions.
His chest pains have disappeared.

9

Resources for Healing:
Stroke

Stanley Riddick:
a New Jersey ‘‘Giant”

Analy§i8 of Early Warnings:

Once a serious stroke occurs, little
can be done except rehabilitative
physical therapy. As a result, medical
scientists have concentrated their ef-
forts in patient treatment and
research on anticipating strokes and
minimizing damage if a stroke should
occur. The key to these efforts at
Columbia- Presbyterian has been im-
proved understanding and manage-
ment of transient ischemic attacks

(TI.\s), the first warning signals of
reduced blood flow, signalled by
transient speech difficulty, numbness
or weakness on one side of the bodv
or by blurred vision in one or both
eyes. Increased understanding of the
nature, presence and significance of
TIAs has led to wider recognition of
pre-stroke symptoms and to earlier
referral of patients who run the risk of
strokes.

Eight weeks and a few days after undergoing
complex cerebral bypass surgery — to restore
mental and physical functioning impaired by a
stroke six months earlier — Stanley Riddick
went back to his job as supervisor in the
maintenance payroll department of the
Meadowlands sports complex, home of the New
York Giants, among other New York and New
Jersey teams. For a man who did not know
when he would ever work again, it was a great
event.

For a major medical center like Columbia-
Presbyterian, experienced in such bypass
surgery, so rapid and complete a recovery was
not unexpected. Nonetheless, Stanley’s
recovery was still a great event for him, his
family, and his surgeon.

There was reason to be pleased. In June, 1980,
when Stanley visited Columbia- Presbyterian’s
Neurological Institute, the mild attacks he had
b<*en experiencing for a year and a half had
taken a serious turn. Stanley, 65, had sensed
tingling and numbness, even what he called a
“clumsiness,” in his right arm and leg. These
attacks — transient i.schemic attacks (TlA’s), the
precursors of a stroke — would last up to ten
minutes and occur once or twice a month. And
they got worse. Hut not until a new symptom
d(*velopcd did he consult an Institute neurol-
ogist. This started as a more seven* weakness
on Stanley’s right side. Before long, his speech
was affecl<*d. Stanley kn**w what he wanted to

say, but he couldn’t find the right words. He
had aphasia, an interruption of the brain
process preventing him from connecting his
thoughts with the right words to express them.
Stanley had a stroke.

Each year, more than 3 million Americans —
average age, 55 — suffer the kind of occlusive
stroke that Stanley had. If all types of strokes
are included, the number of Americans affected
exceeds 4 million. Statistically, the U.S. has
one of the highest incidence levels in the world.
Strokes account for the third most frequent
cause of death in America (after cancer and
heart disease) and the nation’s most frequent
cause of long-term disability.

Stanley Riddick did not have to be told that his
speech difficulties meant something very
serious. At the Neurological Institute, he was
given a set of tests, including a cerebral
angiogram. Among other things, this X-ray
reveals the condition of the internal camtid
arteries. The internal carotids, one on each side
of the head, have the critical task of
su|)plying blood to the part of the brain respon-
sible for perceptual and speech abilities. In
Stanley’s case, the angiogram mvealed what
ap|)eared to be a complete oeclusion of the left
internal carotid.

Staidey’s surgeon was Dr. James W. (iorrell, a
2.5-year veteran of neurosurgei'y at Columbia-
Presbyterian and a pniminent sjiecialist in

S<‘un-liiiif{ for AltiiomiuIilifM:

A hall<‘n ol liiglilv sophist icalcd tests
can he atliniiiistereil hy neun)lopists
at (ioliimhia-Preshyterian to identify
and gauge the ahnonnalities in ar-
teries which might cause a stn>ke.

The angiogram, one of the most de-
finitive of siieh tests, pmduees very
reliahle \-rays thningh the use of dye
injected via a catheter. Digital
radiography, one ol the most ad-
vanced (and safest) means of testing,
is now used at (iolnml)ia-Preshvterian
(and only several other medical cen-
ters in the country ) to n*veal, again
with the use of injected dye, im-
mediate computer images ol arteries.

<%T .ScaiiiHTs:

.A team of (iolumhia- Preshyterian
scientists has made an ini|)n)vement
to the (Center’s (iomputeri/ed .Axial
'li)tnographer ((i-T) scanner that
makes possible image detail un-
matched hy any other C-T scanner in
the world. The scanner pnxiuces im-
ages every five seconds and allows
neun>radiologists and neurosurgeons
to study the size and shape of an an*a
of hrain damage with gn-at precision.
The e(|ui|)ment is also used to study
the eye, orhit and pituitary gland with
unmatched detail n'lidition.

Neiir«»surg»‘ry:

Neunrsurgeons at (arlumhia-
Preshyterian perform a wide range of
sp«‘cialized operations that can pre-
vent a stnrke. One ol the most im|)or-
tant of these surgical technirpies —
canrtid artery endarterectomy — was
first performed at (iolumhia-
Preshyterian more than 20 years ago.
The pnrcedure ittvolves removing
from the arterial walls th<‘ plarpie that
can ()hig up the artery or serve as a
■soun'e of fragments which might
hreak away and travel in the
hloodstrt'am to block small arteries in

the hrain. These blockages, in more
than 90% of cases, are the cause of
sym|)toms which can lead to stroke.
Researchers hope to discover nonin-
vasive techni(|ues — perhaps chemi-
cal agents — which can prevent the
abnormal deposition of material in
the inner lining ol arteries, known as
“hardening ol the arteries,” [)revent
the degenerative changes that occur
in these deposits, and [trevent the
liberation of fragments which lodge in
small arteries of the hrain and cause
most of the damage.

Stroke rant.

Microneurovascular Surgery:

I)es[)ile its signifirance for most
stroke- risk patients, eanitid artery
endarterectomy cannot i)c performed
for patients whose cerel)ral arterial
lesions are not easily accessible. At
Columbia- Presbyterian, a highly spe-
cialized bypass technitpie is used in

Stanley Riddick coat.

microneun)va.scular surgery. The
advanced, complex pnx edure (per-
fonned by relatively few hospitals in
the country) requires connecting ac-
cessible arteries — those outside the
skull to those inside the brain — thus
redirecting blood flow around the
occlusion.

Simultaneous Cerebral and
Coronary Bypass Surgery
By the time a patient undergoes
cerebral arterial or vascular surgery,
an intensely collaborative pmcess has
taken place whereby the skills of a
great many specialists and the most
advanced techni(|ues of medical sci-
ence have been bmughl to bear on the
diagnosis and treatment of the dis-
ease. The opinion of a canliologist,
for instance, is routinely sought prior

to surgery to make sure the patient's
heart is stn>ng enough to withstand
the stress of surgery. In the majority
of instances it is. If death occurs dur-
ing surgery, it is often due to stress-
related cownary failure in already
weak hearts. For these cases, sur-
geons at Columbia- Presbyterian
today can perform simultaneous
cerebral bypass surgery and con)iiar\
bypass surgery.

cerebral revascularization. Despite the
evidence of the angiogram, Dr. Correll felt that
blood flow through the blocked carotid might
possibly he re-established.

He decided to perform exploratory surgery. On
June 18, the left carotid artery in Stanley’s neck
was exposed and opened. The occlusion was, in
fact, complete. Because the blockage could not
he cleared. Dr. Correll could not re-establish
blood flow. He did, however, increase flow
through the external carotid artery, which sup-
plies l)lood indirectly to the brain. This stej)
improved Staidey’s condition.

On June 25, Statdey began a program of physi-
cal and speech therapy which would continue
after he was di.scharged from the Hospital on
July 1. By then, after oidy a week of therapy as
an inpatient, Stardey was able to speak more
accurately and use his right arm and leg more
fully.

Stanley’s physical therapists tailored programs
to his needs and to his pace of recovery. His
weakened muscles grew stronger daily. In
treating his aphasia, s|)ccch thera|)ists
retrained Staidcy to pick out and use the right
words.

Katherine Riddick, too, was included in the
Hospital’s rehabilitation program. .Anxious for
her husband’s rapid recoveiy and return home,
Mrs. Riddick already bore the responsibilities
of her job as a teacher. Now, there would he
other responsibilities. Stanley could no longer
drive a car. He was often unable to read or
interpret the written word [)recisely. He wn>te
only with difficulty, and tnemoiy lapses
prevented him from recalling names. Mrs.
Riddick had to help him. At Columhia-
Preshyterian, specialists in stroke medicine
know that the families of stroke patients need
understanding and support in their own right.
Dr. Correll wanted to spend time, and did
spend time, with Mrs. Riddick.

At his hometown hospital Statdey continued his
rehabilitation. He visited Dr. Corndl in New
Yitrk every few weeks. But after several months.
Dr. (iorndl was less than satisfied with the rate
of Stanley’s improvement. Stanley could not go
hack to work. In December, convinced that
soiiK'thing more had to he done. Dr. Correll
readmitted Stanley to Columhia-Preshyterian
for by pass surgeiy.

Microneurovascular surgery, as its name
im|)lies, is miniaturized, delicate surgciy cm
tin- blood vessels .serving the brain. Kv«‘n
though Columhia-Preshyterian had a
considcrahh* track ivcord in somewhat similar
surgery. Dr. Corndl did not ivcommciul this

12

Klooti for riiroiiiitoMiH

Till' work ()l (ioluniliia-l’ri'slnti'rianV
Tlironiliosis Ki'si'an li (imu|) may
liavf >if;niri<'anl lii-ariiif’ lor ihosf who
risk or liavi- siifli'rcd a s-lmkr. Invi's-
lipalors are' sci'king to |m'ilii t anil
iili'iilih till' orcum'iici' ol ihnimhosis
— a major larlor in siniki's — ihroiif'li
till' usi' ol lilooil tests. It is hopi'il that
a hlooil test ean he ilevelo|)eil whieh
will ileteet thromhoemholisms helore
the\ oeeiir.

Kehuliililation

For the best eham e ol stiecess, a
stmke rehabilitation pmgram shoiihl
bepin as soon as possible alter the
stmke occurs. .\t (iolumbia-
I’ri'sbi terian. the program ineliiiles
exercises anil other therapies as well
as moililieil eanliovaseiilar stn'ss test-
ing anil n'gular monitoring ol the
patient's ri'sponse to the stress o( the

n'habilitation pmgrarn. I'he conei'iit
ol rehabilitation has been broadened
to inelude care lor the psychological
and emotional needs ol the patient's
lamilv. \ new lilm and book, both
pn'pared by (iohimbia-l’resbyterian
speeialists, explore the pmblems
raised by stmke and help the families
ol stmke victims deal with these
pmblems.

PKT Seaiinern:

I'he critical ability to distinguish
subtleties of cell functiou and metab-
olism in the brain (which the (^-’f
scanner cannot accorn|)lish) holds
enormous |)mmise for determining
whether brain damagi' is reversible.
Ill pmvide the advanced diagnostic
ca|)ability ol this new testing tech-
nology, (Columbia- Presbyterian is
seeking funds to acipiire the Posi-
tmn K.mission ’liimographer (PKT)
scanner. I'lie Department ol Kadiol-
ogy has assembled a gmup ol
physicists interested in diagnostic
imaging.

bypass operation lightly. But for Stanley
Riddick, the alternative was a burdensome
semi-invalidism.

Staidey was readmitted on December 4. On
December .5, Dr. Correll performed bypass
surgery, anastomosing, or connecting, the left
superficial temporal artery (an extracranial
artery) to a branch of the left middle cerebral
artery (an intracranial artery). A postoperative
angiogram carried out on December 9 indicated
to Dr. Correll that the surgery had been
successful: the plugged carotid artery had been
effectively bypassed by connecting other
arteries and redirecting blood flow. The flow of
blood was now very brisk.

Stanley’s condition began to improve rapidly.

He continued both physical and speech
therapy, but by the end of January the need for
it was over. On February 20, Stanley Riddick
went back to work.

13

Resources for Healing:
Highlights of T^rk in Progress

Anatomy

Of special interest in the
Anatomy Department s 1980
research was the discovery, in
the intestinal tract, of a type of
nerve cell that is also present,
and of key importance, in
brain tissue. The neuron in
question uses serotonin as its
transmitter, and has been imp-
licated in brain dysfunction.
The opportunity to study it in
the more accessible site may
lead to new understanding of
nervous system abnormalities.

Anesthesiology

A team of investigators in the
Department of Anesthesiology
is examining the potential
benefits and risks for the fetus
that are associated with drug
therapy used to alleviate [)ain
and agitation of the mother.
This group is also investigating
the factors governing placental
transfer and fetal uptake of
narcotics.

Biochemistry

In 1980, the Department
began to expand its biophysics
staff to explore more deeply
the relation within living
molecules between structure
and function. Advanced X-ray
diffraction techniques, com-
bined with computer analysis
of possible structural patterns,
are revealing the links between
the shaf>e of a bacterial or viral
molecule and the way it
behaves. Such resean h will in
time bear fruit in studies of
normal and pathological cellu-
lar behavior.

(iancer

One of only 21 (Comprehensive
(Cancer (Centers in the nation,
(Columbia- Presbyterian’s
(Cancer (Center/Institule of
(Cancer Research recently
began o[H‘rati()ii of a com-
puterized Patient Research
Data Rase to be used to im-
pn)ve patient car«‘, teacliing
and research. The (Center also
has a computer-based clinical

display system that reports key
clinical information on a wide
variety of neoplastic diseases.

Dental and Oral Surgery

The School of Dental and Oral
Surgery, in association with
the Department of Pediatrics,
is now offering complete den-
tal care to physically handi-
capped and emotionally dis-
turbed patients who otherwise
might not receive any care. A
Special Services Clinic, re-
cently completed as part of the
School’s renovation, serves as
the focal point for the delivery
of dental care to the handi-
capped by the School’s dental
residents.

Dermatology

Studies of the sensitivity to
ultraviolet light of cells of the
skin of patients with defects in
the DNA repair mechanism
continue in the Department of
Dermatology. Department
scientists are also assessing
cellular sensitivity to the
mutagenic and carcinogenic-
effects of ultraviolet energy.
This research is a vital link in
the understanding of the
mechanisms and causes of
skin cancer.

Epidemiology

Columbia- Presbyterian’s
(Gertrude H. Sergievsky Center
focuses its work on studies of
preventable causes of di.sor-
ders of the central nervous sys-
tem. Resean h there also has
established that the risk of
sfKjntaneous abortion is in-
creased by even moderate con-
sumption of alcohol by preg-
nant women. One effect of
maternal drinking is the risk of
fetal alcohol syndn)me.

Human Nutrition

The effects of matenial nutri-
tion on pregnancy arc being
explored by investigators in
the Outer’s Institute of
Human Nutrition. The rc-
sean-h demonstrates that un-
demourished mothers have a
lower expansion in plasma
volume, which is likely to n--

M.

(luce the birth weigiil of their
l)al)ies. Other studies are
examining the effects of alco-
hol and coffee consumption
during pregnancy on placental
gn)wth and the subsecjuent be-
havior of the baby.

Medicine

Investigators in the Rheuma-
tology Division of the Depart-
ment of Medicine are studying
the function of gene pnulucts
of the genetic mechanism re-
sfKXisible, in part, for contn)l-
ling immune resjtonse. In
addition, these investigators
are studying T-cell differentia-
tion antigens expressed on
functionally distinct im-
munoregulatory subsets. Pre-
cise analysis of these genes
and differentiation antigens
should pn>vide insights into
the mechanisms involved in
the development of rheumatic
diseases such as rheumatoid
arthritis and systemic lupus
erythematosis.

Microbiology

The Department continues to
focus its resean-h efforts on the
intn>duction of genes into a
variety of mammalian cells.
The purpose is to learn more
about how viruses act ufxm
cell tissue by exchanges of
DNA, and thus about viral
infection.

Nursing

As the course of medicine
changes, nursing must also
change if the partnership be-
tween physician and nurse is
to work effectively on behalf of
the patient. During 1980, the
Center’s Nursing Services
were restructured to eliminate
unneeded layers of manage-
ment between the staff nurse
and her senior supervisors.
The result is greatly improved
communication among the dif-
ferent nursing services, more
efficient use of personnel,
livelier and more stimulating
consultation between in-
dividual nurses, and higher
morale.

15

Ophthalmology

The physiological (jualities of
tear film on the surface of he
cornea are important determi-
nants of corneal transparency,
good vision, and occular com-
fort. Pioneer studies of the
chemical composition of tears
are now being applied by the
Department of Ophthalmology
to a variety of clinical pn)b-
lems using new, refined tech-
nifjues of immunochemical
analysis.

Orthopedic Surgery

The pn)rnise of specific puls-
ing electn)magnetic fields
(PEMFs) in therapy for un-
united fractures is well estab-
lished. The effect of Pf^MFs,
small electrical currents that
are passed thmugh damaged
bone or other body parts, con-
tinues to be of great interest to
the Department of Orthopedic-
Surgery. PF>MF's are being
actively investigated by the
Department for treating a wide
variety of orthof)edic ills more
effectively.

Otolaryngology

A recently inaugurated
otoneun)logy clinic brings to-
gether a multidisciplinary
team of specialists in otolaryn-
gology, neurology, and neuro-
surgery for diagnosis and
treatment of a number of dis-
onlers of the head and ear in-
cluding Bell’s Palsy, tinnitus,
vertigo, hearing loss, and
tumors involving the ear and
base of the skull.

Pathology

I he use of a portable pumj) for
insulin delivery has recently
been intnnluced by the De-
partment of Pathology and
Pediatrics in management of
unstable diabc-tes mc-llitus in
childrc-n. Investigators in the
de|)artment studying [M)ssibl«‘
genetic links to diabc-tes have-

K)

y ^

found substantial evidence of a
genetic predisposition for
juvenile diabetes, inherited as
a recessive trait closely related
to the immune response region
of the HLA gn)up of genes.
Pharmacology
The enormous difficulty of
dealing with the problems of
toxic waste and environmental
poisoning was brought clearly
into focus by a series of na-
tionally publicized crises such
as the Love Canal incident.
Because of the critical need for
specialists to handle these
problems, the Department of
Pharmacology and the Di-
vision of Environmental Sci-
ences of the School of Public
Health are accelerating joint
efforts to provide doctoral
training in toxicology and
environmental science.

Physiology

The mechanism by which vit-
amin D regulates absorption of
calcium is under study in the
Department of Physiology.
There, investigators have dis-
covered and purified a vitamin
D-dep>endent membrane pro-
tein which binds to calcium
with high affinity and appears
to be an integral part of the
intestinal transport mech-
anism. These and other
studies exploring the molecu-
lar organization and function
of biological membranes are
critical to understanding a
wide variety of clinical prob-
lems, including nutrition,
heart disease, and cancer.

Psychiatry

Many regularly used antide-
pressant drugs may cause seri-
ous cardiovascular toxicity in
the aged. The safety of these
drugs is in question when
given at the usual oral dose to
elderly patients, who are al-
ready at high risk for car-

diovascular disease. Clinical
investigators in the Depart-
ment of Psychiatry are study-
ing this pn)blem in an attempt
to develop reliable procedures
which will enable the physi-
cian to choose the best treat-
ment for depression while
minimizing the risk of canliac
arrythmia and sudden death.
Public Health
I’he School of Public Health’s
Division of Population and
Family Health is developing a
Comprehensive .Adolescent
Care Program to meet a wide
variety of medical and social
service needs of this often neg-
lected group. In onler to reac’h
these young people, the cen-
ter, thn)ugh its Health Educa-
tion Unit, has embarked on an
intensive community educa-
tion program using such tools
as a mobile health van, films
and flyers, and a community
health fair.

Radiology

Interventional radiology — the
use of radiologic procedures to
actually treat disease — is
under continuing development
in the Department of Radiol-
ogy, an early pioneer in the use
of these nonop>erative tech-
niques. Angioplasty, the inser-
tion of a catheter to dilate a
narrowed artery, is now being
used with great effectiveness to
treat blockages and constric-
tions in arteries of the kidney
and legs that would otherwise
require surgery.

Urology

The Department has been
conducting experiments in the
use of “ultrasound" — ex-
tremely high-pitched sound-
waves— on cancerous tissue.
The effect of ultrasound is to
overheat the tissue. In cases of
adenocarcinoma in rats, the
treatment markedly reduces
the size of the tumor, and, in
20 {jercent of the total cases, it
eliminates the cancerous
growth.

17

Financial and Statistical Review ^

The Presbyterian Hospital in the City of New York

Statements of Revenues and Expenses and Changes in Unrestricted

Fund Balances for the Years Ended December 31, 1980 and 1979 (In Thousands)

Operating Revenues:

1980

1979

Patient service revenues

$180,845

$170,390

Allowances and uncollectible accounts

(23,135)

(26,123)

Net patient service revenues

157,710

144,267

Other services

9,298

8,535

transfers from specific purpose funds

4,228

3,584

Total operating revenues

171,236

156,386

Operating Expenses:

Salaries and related fringe benefits

123,349

111,533

Supplies and other expenses

49,828

44,128

Depreciation

7,483

6,887

Total operating expenses

180,660

162,548

Loss from Operations

(9,424)

(6,162)

Non-Operating Revenues:

Investment income

5,762

5,037

D'gacies and contributions

2,228

1,584

Realized net gain on sales of investments

245

164

Total non-operating revenues

8,235

6,785

Revenues Over (Under) Ex{)enses — Before

(Cumulative Effect A«ljustment

(1,189)

623

(Cumulative Effect on Prior Years of Change in

Method of Accounting for Vacation Pay

(2,078)

Revenues Over (Under) FCxpenses

(1,189)

(1,455)

Fund Balance, January 1

101,945

110,063

(Cumulative ICffecl on Prior Years of (Change

in

Method of Accounting for Investments
transfers from (to) Restricted Funds for:

(4,995)

Additions to pro[)crty, plant and e(pii|)ment

11,875

5,219

Funding of depreciation

(7,483)

(6,887)

Fund Balance, Decemher.'il

$105,148

$101,945

lii-Palieiit Statistirs/Year 1980
lied

{Com|)lcmcnl Admissions

Patient
Days '

Percentage

of

Oeeupaney

Average
Length
of Stay

Private

293

9,612

84,907

81.2

8.62

Semi-Private

()67

21,789

204,072

84.2

9.41

Ward

33 1

10,309

94, 1 ()7

78.2

9. 16

'Idlal 1

,291

41,710

383, 1 4()

82.0

9. 1 b

Nursery

18

3,305

13,321

74.3

4.26

Vaiiderhilt (Clinic

1 980

1979

Number of Visits

Medicaid

1 6 1,. 584

Ik), 497

Medican'

79,761

74.8()7

llliH' (Cit)ss and Blue Shield

7,682

5,2.50

(Charges and mi.seellaneous

ag<MU‘i(*s

78,196

69.»133

Full Pay

6,744

6,')<)4

Pail pay

.59,382

61,. 545

Five, transfers and follow-u|)s

—

2.55

Personnel and de|)endents

20,8.56

21,()74

'I'olal

414,205

387.015

Doctors ( )ffices

2()3,12<)

2(> 1,327

(h'aiul Jotal

(>77,334

(>«1,342

'A ctmiplrli* financial n*pt>i1 can l»c ohlaimai

li\ writing the

(!<ilimiliiil-l’n'sli\lrriaii VIcilii al (a'lilri I'uia

1. Inr.. KKI II

aNrn

AvriMH*. Siiilr 2*h), Nr\s Vnk. N.A. 10032

18

Columbia University in tlie City of New York

Health Seienees, Revenues and Kxpenditnres (In Thousands)

1980

1979

(iciUTal Income

S 28.9 fS

S 23.023

Kcslriclcd

108.121)

90.807

Kx[)eii(litiircs
(jt'iicral Income:

137,171

1 1 1, 130

Academic

9.0 U

7,717

l,il)rarics

010

227

Huildings-dmimds

7.522

0.299

licgislrar

387

352

Hcnl

1 ,092

801

Sccuritv

Endowments, (iifls. Receipts for

003

008

Sp<‘<‘. Purposes

19.707

10.578

(jctverninent (Grants. Contracts:

Researcli/Training

39.715

31.229

Service

18,007

10.000

Total Expenditures

SI 27.377

S 100.811

Available for Central Services

9,991

7.580

Program Enrollment

1980

1979

Medicine

618

613

Pli.D. in Basic Sciences

193

174

■Nursing

527

519

Public Health

172

398

Occupational Therapy and Physical Therapy

105

109

Psvchiatric Clinic

31

34

Faculty of Medicine Total

1,916

1,847

Dental and Dental Post-Graduate

266

264

Dental Hygiene

56

53

Total, Facultv of Dental and Oral

Suigerv

322

317

Total Health Sciences

2,268

2,164

19

Financial Review

The story behind the numbers

Presbyterian Hospital

Although Presbyterian Hospital offers an ex-
ceptionally coin]ilex range of medical services,
its financial operations, like those of most
major hospitals, are straightfomard. Every
year, Preshvterian gains its operating income
from its net charges to patients — paid mostly
hv such “third parties” as Medicare, Medicaid,
Blue Cross/Blue Shield and medical insurance
companies. And everv’ year, Preshvterian must
meet its operating expenses. Of these, roughly
two-thirds represent the salaries and the pen-
sion and other Ixmefits oi the 6,000 men and
women on the hospital staff. The remaining
one-third is outlav for the supplies and equip-
ment the hospital needs and flepreeiation of the
physical plaiit.

A glance at the figures for 1980 gives meaiung
to the storv. In 1980, Presbyterian took in
•S157.7 million from routine service charges.
Another .S9.3 million came in from other tv[)es
of services, and an additional S4.2 million was
transferred from (mdowment and research funds
to help (hdray the cost of the year’s research
and teaching expenses. In all, 1980 operating
n'v<mue ecpudled .$171.2 million.

dotal ('xj)enses canu' to $180. 7 million. As
in every year since 1969, Presbyterian opeuated
at a defieil. The 1980 (hdicil, .$9. .3 million,
ecjualled about .3. .3 per cent ol total revemiu'.
The deficit, although sfuious, was oidy about
half the size of tin* 1977 operating deficit of
.$18 million.

'll) offset th<‘ (hdicit, Presbyterian Hospital was
forced to transfer to its o|)erating fund .$6 mil-
lion in endowment income and .$2.2 million in
eiirrent eontrihutions and legacies — money
which should have gone' to stimulate and sup-
port advances in cliincal medicine.

The Division of Health Sciences
of Columbia University

The faculties of medicine, nursing, occui)a-
tional therapy, physical therapy, public health,
dental and oral surgery and dental hygiene , and
the psychoanalvtic clinie collectivelv make
up the Division of Health Sciences, which is
the partner of Presbyterian Hospital in the
Columbia- Presbyterian Medical Center. The
Division of Health Sciences, although it is
closely linked to the hos|)ital through an indis-
sovahh' agreement, is in organizational terms a
separate institution. As one of the graduate in-
stitutions of Columbia University, it coordinat(‘s
its educational functions with Columbia.

In 1980, the Division of Health Sci«mces took
in income of .$1.37.3 million. About one-fifth of
its income (.$28.9 million) was derived from tui-
tions and fees and state education allowance.
The balance, .$108.4 million, cuune almost
entindy from grants and f(‘cs r<“stricted to
biomedical research. Th<* Division laid out
.$19.2 million of its general n-venues on its aca-
demic programs and premise's. \'irtuall\ (‘ven
dollar of receipts for rt'search was e“X|)endcd.
riit' excess of geiu'ial income reve'iuies over
geiu'ial expe'iiditnres, of about .$9.9 million,
was turned ov{*r to Columhia lor financial and
adtiiinistrative support.

What the I\iimh<‘rs Heveal

For Presbyterian Hospital, the 1980 figures re-
llect a widcs|)r('ad |)attern. VirtualK evcr\
majoi' health care' institution \sith respon-
sibilities lor the poor and near-poor laces
chronic (h'licits. I'o cover the medical costs ol
those with neither he'alth insurance nor the
means to |)a\. th<‘ Hospital must draw on th<‘
income hom its endowment. In so doing, it lit-
erally borrows against its future. Funds that
would otherwise he committed to impi'oving
patient cai'c and advancing clinical research
must h(‘ diverted to mc('t curi'cnt obligations.

Stringent mairagcmcnt |)i'occdurcs ai'c now
helping to kcc|) ('Xpcnscs — and deficits —
under control, hut in a hospital, where lilc itscll
is so often at stake, thci'c is a limit to what

20

(‘Ilicit'iit manapcmrni can accomplish. Tlic
poor camiol he denied nt“(“dcd medical assis-
tance in order to halanc«‘ the hndgel.
Douhh'-digit inllalion. and the costs ol inen-as-

$ Millions

30

20 I

P

1970 71 72 73 74 75 76 77 78 79 80

Presbyterian Hospital
Operating Expenses and Revenues
in Current and Inflation-adjusted Dollars

ingly complex medical technology, have marie
the tasks facing the Hospital’s management
even more difficult. Yet. much progress has
been made. As the table above indicates,
Presbyterian Hospital's operating costs, ad-
justed for inflation, have actually declined
since 1976. Unfortunately, so have inflation-
adjusted revenues.

These figures reveal one key truth: the enor-
mous significance of private philanthropy. De-
spite the inflow of tens of millions of dollars in
third-party payments, the gifts and legacies of
private donors remain the Hospital’s chief

sourc(> ol funds lor I he improvmneni of palieni
care and the advancement ol clinical research
on which tin* future course ol medicine rests.
The figures lor the Division of Healih Sci«‘nces
t»‘ll a similar stor\. For example, the federal
“capitation ” grants, which channeled into med-
ical schools as much as $2,100 per year per
enrolled student, are being n'duced and will
shortly be eliminated. Federal funds for new
hospital and medical-school construction arc
(Irving uj). And federal su|)port lor biomedical
research and development, which flows largely
from the National Institutes of Health, has
barelv kept pace with inflation.

This means that in real dollars, as the gra[)h
below indicates, federal support is now de-
creasing. In time, this drop will Iun1 ever\
academic medical center.

The issue, in sum, cannot be more clear. In-
creasingly, the future of great centers of health
care, and the teaching and research which sus-
tains health care, will depend on the under-
standing and the generosity of private donors
and less on direct govennnent support.
Columbia- Presbyterian Medical Center is con-
fident that the private sector will respond to its
call for support. And proud to be considered
worthy of support.

$ Billions

1970 71 72 73 74 75 76 77 78 79 80

f’t'deral Expenditures lor Ibudtii
Care Research and Development in
(airrent and Inflation-adjusted Dollars

21

Resources for Healing

Concluding Report on the MEDI/CENTER 1 Campaign

Nearly eight years ago Colurnbia-Presbyterian
Medical Center launched the most ambitious effort
in its history to secure private philanthropic
support: MEDI/CENTER 1. Under the auspices of
CPMC Eund, Inc., the Medical Centers
development organization, this major capital
campaign sought over $100 million to modernize
the Center’s aging physical plant and to increase
the research and teaching endowment which has
traditionally been the well-spring of the Center’s
excellence.

Although MEDI/CENTER 1 was the product of
years of careful planning and analysis, the
campaign was ultimately based on trust — trust that
the Center’s friends would give even more gener-
ously than they had in the past and trust that new
friends would come to believe in the vital mission
of the Center and reach deeply to support it.

vate biomedical academic centers the world’s finest
institutions for research, education and patient
care. Under the leadership of Harold H. Helm,
Chairman of MEDI/CENTER 1 until 1979, Ralph
E Leach, Mr. Helm’s successor as Chaiirnan, and
Co-chairman Robert D. Lilley, and through the
efforts of a small army of the Center’s alumni,
friends, and staff, a victory for private philanthnipy
at Colurnbia-Presbyterian has been won.

Generous private support has sustained and
strengthened Colurnbia-Presbyterian, as it must
again in the years to come. A great academic
medical center must constantly renew itself as the
science and art of medicine evolve. While
MEDI/CENTER 1 has been a resounding success,
it is hoped that through CPMC Fund, Inc., ongoing
needs will again be met as the Center continues to
provide the finest medical care in the world.

The trust has now been fulfilled. MEDI/

CENTER 1 has raised nearly $115 million from
individuals, foundations, and corporations. Nearly
75 percent of that total has been designated to
support the work of the Division of Health Sciences
of Columbia University, the scientific and
intellectual foundation of the Center’s quality.

Money itself, though critically important, is,
however, not the final measure of the success of the
campaign. What matters most is what this new
su[)port will mean to the future of Colurnbia-
Presbyterian, its staff, and all tliose it .serves.

By this measure, MEDI/CENTER 1 lias been an
extraordinary achievement. Some examples of that
achievement an* highlighted briefly below.

In the final analysis, MEDI/CEN d'ER 1 is a
triumph of the spirit of volunteerism that has
played so great a mie in making America’s pri-

22

Some Major Accomplishments
of the MEDI/CENTER 1 Campaign

Building and Renovation

School of Dental and Oral
Surgery

T()tal renovation and re-e(]ui[)ping
of dental clinics, teaching
facilities, and office areas.

School of Public Health
Complete renovation of its
facilities including classn)otns,
study areas, student lounge and
office areas.

College of Physicians and
Surgeons

Major upgrading and renovation of
five floors of the P&S Building
including the Departments of
Medicine and Neurohiologv, the
Muscular Dvstn)phy Muscle
Center, and a new Faculty Center.

Julius & Armand Hammer
Health Sciences Center
and Augustus Long Library
A new 20-story tower housing one
of the nation’s leading medical
libraries, a large auditorium with
full audio-visual facilities, a video
production studio, modern
teaching facilities, and extensive
research laboratories.

Presbyterian Hospital
Funds have been raised toward:

• Eye Institute renovation and
re-equipment

• Vanderbilt Clinic renovation and
expansion

• Babies Hospital renovation and
expansion

• general endowment and other
construction projects

Endowment

Creation of 13 Fully
Endowed Professorships

• Sidney (barter
Chair in Neurologv

• Jose M. Ferrer
Chair in Surgerv

• A. David (iurewitsch (duur in
Rehabilitation Medicine

• Johnson & Johnson
(diair in Surgerv

• Robert Wood Johnson, Jr.

(]hair in Biochemistrv

• Lawrence il. Kolb
(diair in Psychiatry

• Robert F. Loeb
(diair in Medicine

• (diaries H. Revson Chair
in Cancer Research

• Gertrude H. Sergievskv (diair
in Epilepsy and Cerebral Palsy

• Frank E. Stincdifield Chair
in Orthopedic Surgerv

• John K. Lattimer
Chair in Urology

• James Winston Benfield Chair
in Operative Dentistry

• Byron Stookey Chair

in Neurological Surgen

Initiation of 17 New
Endowment Funds
including:

• 12 partially funded
professorships

• two lectureships

• one prize fund

Six of the partially funded proles-
sorships are at least hall-way to their
goals. New and growing projects
such as these highlight the
continuing need for the support and
generosity of [irivate philanthropy.

Executive Committee of
The Fund for MEDI/CENTEK 1
*A.J. Binkert
Benjamin J. Bultenwieser
John W. Brooks
riiomas H. (dioate
Felix F. I)(‘tnartini, M.l).

(Jarl W'. Desch
*Fredrick M. Eaton
Mrs. Edward H. Gerry
Harold H. Helm, Chairman Emeritus
Richard N. KersI
John K. Lattimer, M.l).

Raljih E Leach, Chairman
Robert I). Lilley, Co-chairman
^Augustus (L Long
Paul A. Marks, M.l).

William J. McGill
Edward H. Noroian
Edward B. Schlesinger, M.U.

Frank E. Stinchfield, M.D.

Dcmald F. Taj)ley, M.D.

Gerard M. Turino, M.D.
f](lward V. Zegarelli, D.D.S.

Leadership Gifts Committee
Benjamin J. Buttenwieser, Chairman
Major Gifts Committee
Mrs. Edward H. Gerry, Chairman
Corporations Committee
Ralph F. Leach, Chairman
Drummond C. Bell, Vice Chairman
Doctors’ Fund

John K. Lattimer, M.D., Co-chairman
Edward B. Schlesinger, M.D., Co-chairman
P«&S Alumni Campaign
J. Lawrence Pool, M.D., Hon. Chairman
Gerard M. Turino, M.D., Chairman
School of Nursing Campaign
Carl W. Desch, Co-chairman
Mrs. Robert James Lewis, Co-chairman

School of Dental and

Oral Surgery Campaign

Edward V. Zegarelli, D.D.S., Hon. Chairman

Joseph M. Leavitt, D.D.S., Co-chairman

Nathan M. Sheckman, D.D.S., Co-chairman

Public Relations Advisory Committee

Kerryn King, Chairman

CPMC Fund, Inc.

Robert Feldman, Executive Director

*H<u>orar\ Member

2.3

Leadership

The Presbyterian Hospital in the City of New York

Trustees anti Officers

Augustus C. Long,

Chairman Emeritus
Fredrick M. Eaton,

Chairman Emeritus
*Thoinas H. Choate,

Chairman of the Board
*Jolin W. Brooks,

Co-chairman of the Board
* Ralph F. L(*aeh,

Vice-Chairman oj the Board
M Financial Affairs
*Felix E. Demartini, M.D.,
President

*George S. Dillon,

Vice President
*VIrs. Fid ward H. Gerry,

Vice President

*Mvles V. Whalen, Jr., Es<|.,
Secretary

Jon H. Katzetd)aeh,

Treasurer

*Kohert H.B. Baldwin,

A ss ista n t Treas urer
*Hulhert S. Aldrich
Edward H. Auehineloss
Drummond G. Bell
Henrik H. Bendixen, M.D.
Ex Officio

Mrs. B. kionda Braga
^Charles L. Brown
*1 Inward L. Clark
*.|ames M. Clark
James j. Daly, Es(p,
*Alexander (iareia, M.D.,

Ex Officio

Ms. Mary B. (ioodhue
*Mauriee F’. (uanville
Leonard C. Ilarher, M.D.

Ex Officio
I lenry IJ. I larder
I lenry II. I lenley, Jr.

*Ms. Lydia Fi. Kess
*'l()tn Killeler

of l\xrrulivr (.cUnmiMer

William F. Laporte
*Alfred L. Loomis, Jr.

William F. May
Barnabas Me Henry, E.sep
Allen E. Murray
*Edward H. Noroian
Donald C. Flatten
*Riehard I. Purnell
*Charles T. Ryder, M.D.

Ex Officio

Mrs. Carll Tucker, Jr.

Cyrus R. Vance, Fisej.

Raymond L. Vande Wide, M.D.

Ex Officio
Alva (). Way
*Sidney J. Weinberg, Jr.

Ralph N. Wharton, M.D.

Ex Officio

Robert T. Whitlock, M.D.

Ex Officio

Honorary Trustees

Malcolm P. Aldrich

August Belmont

F.dward (i. Bench

Roger M. Blough

W. Sheffield Cowles

F rederic G. Donner

J homas (i. F'ogarty

James W. FOley

John A. (ufford

Lauder (ueenwav

Perry E. Hall

Harold II. Helm

Frederick R. Kapjad

Mrs. Robert Jatties Lewis

Augustus C. Long

Sammd W. Meek

R(“V. John (). Mellin, D.D.

Charles S. Payson

Rev. Norman Vincent P(“ale, D.D.

I )orranee Sexton

Benjamin Strong

Mrs. 1 lenrv C. liiylor

Mrs. Sheldon Whitehouse

Rev. riiomas F,. Wilson, D.D.

Robert Winlhro|)

Administrative Staff

Felix E. Demartini, M.D.

President

Edward H. Noroian

Executive Vice President
Charles T. Ryder, M.D.

Executive Vice President for Medical Affairs
Thomas Blumenfeld, M.D.

Director of Medical Affairs
Joseph P. Corc-oran

Vice President, Finance
John De Stefano

Director Information Systems
Eugene M. Devine

Vice President, Support Services
William E. Duffy

Vice President, Personnel
David L. Ginsberg

Director of the Office of Planning

Martha E. Haber, R.N.

Vice President, Nursing
Calvin P. Hatcher

Director, Ancillary Services
David Lindsay

Director of Management Audit
James Z. Metalios

Director of Physical Plant
Richard P. Zucker

Director, Public Interest

21

Columbia University

Trustees

riiomas L. (lluTstie
Joseph I). (a)l(e<‘, Jr.

*Daniel F. CiDwley
*Tli()inas 1). Flynn

Chairman, Committer on
the Health Scienres
*\\ illiam (iolnh
*l)avi(l B. Hertz
*Sanuiel L. H ipginhottoin
*Joan \\. Konner
Arthur B. Kriin.

Chairman
Peter K. Loeh
Charles F. Liiee
Thomas \I. Macioee
Connie S. Maniatty
*Vialsh McDermott
Charles M. Metzner
G.G. Michelson
Martha T. Muse
George A. Perera
'iXarren H. Phillips
Michael 1. Sovern.

President

Arthur O. Sulzberger
Ann Sund
Stanley L. Tenko
Lawrence E. \^alsh.

Vice Chairman
Clark \^escoe
*M. Moran \^eston

Trustees Emeriti

William A.M. Burden

Benjamin J. Buttenweiser, Clerk

Lester D. Egbert

William T. Gossett

Grayson Kirk

Robert D. Lillev

William J. McGill

Harold E McGuire

Maurice T. Moore

William S. Paley

William E. Petersen

Harold A. Rousselot

Walter H. Sammis

Alan H. Temple

Samuel R. Walker

COLUMBIA UNIVERSITY LIBRARIES

0050076159

ill the City of New York

Health Sciences Faculties
and Administrative Officers

Michael I. Sovern

President of the University
Henrik Bendixen, M.l).

Acting Provost and Vice President
for Health Sciences
Frederick B. Putney, Ph.l).

Deputy Vice President for
Health Sciences Administration
John Fiorillo, M.A.

Assistant Vice President for
Health Sciences Administration

Donald F. Tapley, M.D.

Dean of the Faculty of Medicine
Jose M. Ferrer, M.D.

Associate Dean for
Postgraduate Education
Frederick G. Hofmann, M.D.

Associate Dean for Admissions
Thomas Q. Morris, M.D.

Associate Dean for Academic Affairs
Norman E. Toy, D.B.A.

Associate Dean
for Administrative Affairs
Inez E. Klinck, B.A.

Assistant Dean for
Academic Administration
Robert J. Weiss, M.D.

Dean of the School of Public Health
Michael O’Connor

Assistant Dean for Administration,
School of Public Health
Helen E Pettit, M.A.

Associate Dean of the School of Nursing
Allan J. Formicola, D.D.S.

Dean of the Faculty
of Dental and Oral Surgery
Sidney J. Horowitz, D.D.S.

Associate Dean for
Academic Affairs
Irving J. Naidorf, D.D.S.

Assistant Dean for
Postdoctoral Education
Gary L. Herrmann, M.B.A.

Assistant Dean
for Administration

Columbia-Presbyterian
Medical Center

(ihairmeii/Directors
of Service and Institutes

Maxwell Ahramson, M.D.

Olitlaruigology, (Chairman & Director

Arthur Bank, M.D.

Human Genetics and Development, Acting Chairman

Henrik Bendixen, M.D.

Anesthesiology, Chairman & Director

Charles J. (iarnphell, M.D.

Ophthalmology, Chairman & Director

John A. Downey, M.D.

Rehabilitation Medicine, Chairman & Director

Isidores. Kdelman, M.D.

Hiochemistry, Chairman

Allan j. Formicola, D.D.S.

Dentistry, Dean & Director

Alexander Garcia, M.D.

Orthopedic Surgery, Chairman & Director
Michael Gershon, M.D., Anatomy, Chairman
Harolds. Ginsberg, M.D., MUrobiulogY, Chairman
Leonard C. Harber, M.D.

Dermatology, Chairman & Director
Brian Hoffman, M.D., Pharmacology, Chairman
Michael Katz, M.D.

Pediatrics, Chairman & Director

Donald W. King, M.D.

Pathology, Chairman & Director

Sidney Malitz, M.D.

Psychiatry, Acting Chairman & Director

Thomas Q. Morris, M.D.

Medicine, Acting Chairman & Director

Carl A. Olsson, M.D.

Urology, Chairman & Director

Keith Reemtsma, M.D.

Surgery, Chairman & Director

Lewis P. Rowland, M.D.

Neurology, Chairman & Director

William B. Seaman, M.D.

Radiology, Chairman & Director

Bennett Stein, M.D.

Neurological Surgery, Chairman <i* Director
John Taggart, M.D., Physiology, Chairman
Raymond Vande Wiele, M.D.

Obstetrics & Gynecology, Chairman & Director

International Institute for the

Study of Human Reproduction, Director

Robert J. Weiss, M.D.

School of Public Health, Dean & Chairman
Center for Community Health, Director

Sol Spiegelman, M.D.

Cancer Centerl Institute of Cancer Research, Director

Mervyn Susser, M.D.

Gertrude H . Sergievsky Center, Director

Myron Winick, M.D.

Institute of Human Nutrition, Director

^Members of Trustees’ Committee
on the Health Sciences

(J()liiml)ia-Presl)\ teriaii
Medical Outer

622-630 West 168th Street
New Y.rk, N.Y. 10032

For information regarding gifts,
grants or be(juests, please contact:

Columhia-Preshyterian
Medical Outer Fund, Inc.
100 Haven Avenue
Suite 29D

New York, New York 10032
212 781-2100